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Medscape
6 days ago
- Health
- Medscape
Identifying, Referring Cataracts in Primary Care
Cataract surgery is the most common surgery in medicine, and the first signs that a patient needs it may come in primary care. Everyone — '100% of people' — will get a cataract if they live long enough, David Rivera, MD, a cataract surgeon in private practice in Westerly, Rhode Island, told Medscape Medical News. The risk increases with age, certain conditions, such as diabetes and obesity, and for those who smoke or take steroids. Nearly 1 in 5 people aged 65-74 years in the US report that cataracts affect their vision. 'Most of the patients I do surgery on are in their 70s and 80s,' Rivera said. Commonly Reported Symptoms Patient reports that should trigger a primary care provider's (PCP's) referral to a specialist 'are blurriness, cloudiness, glare, halos around lights at night, and dull colors,' Rivera said. And though surgery is the only way to eliminate cataracts, surgery is not always immediately necessary, he said, unless patients report that their diminished vision affects everyday activities, such as driving, reading, or watching TV. One key question to ask a patient reporting symptoms, Rivera said, is whether vision fluctuates. If the patient has clear vision when they start reading, then blurriness as they continue, 'that's almost always dry eye,' he said, which can be treated with artificial tears and other lubricants. 'Whatever cataracts blur is going to be constant.' PCPs May Be First to Spot Cataract Signs Philip Eskew, DO, JD, MBA, a family physician in Mauldin, South Carolina, and vice president of Clinical Development at Proactive MD, told Medscape Medical News he often is the first to see signs of cataracts in his patients. He said he routinely checks for cataracts and other eye conditions in well visits, particularly for patients with diabetes or hypertension, using a panoptic ophthalmoscope. Though panoptic varieties are less common in primary care offices, most PCPs use ophthalmoscopes, he said. Ophthalmoscopes aim a light into the eye onto the retina, which reflects a typically reddish-orange light (though the color can vary with skin pigment) if the eyes are healthy. 'If you've got a severe cataract, you're going to see that red reflex, and instead of being nice and red, it might be more white and cloudy,' he said. 'Because ultraviolet [UV] light can contribute to cataract development. Eskew said, 'If you've got a patient who does a lot of outdoor work, especially in the sunshine,' that person may be at higher risk for cataracts, he said. Similarly, if patients have a long driving commute and are squinting into the sun, they may be at higher risk without UV-blocking sunglasses. 'We refer patients for [cataract] surgery when they have impaired vision, glare sensitivity, or trouble driving at night,' Eskew said. He added that insurance requirements are important to consider. 'Some insurance companies use a visual acuity of 20/40 or worse as a benchmark,' he said. 'Some might require documented best-corrected visual acuity of 20/60 or worse in both eyes.' Annual Vision Screening for Patients With Diabetes The most common vision-related referral from primary care is for patients with diabetes, Rivera said, and PCPs typically refer them for annual screening. People with diabetes are at higher risk for both developing cataracts and developing them at an earlier age, according to the American Diabetes Association. With any suspicion of an eye condition, a PCP can refer to either an optometrist or an ophthalmologist, Rivera said. 'If you're suspicious of a more complex condition, you may want to go directly to an ophthalmologist.' Sudden loss of vision should trigger an ophthalmologist referral, he said. 'That's almost never routine.' Children May Have Cataracts Though cataracts are more typically seen in older adults, 'finding them and treating them is crucial in kids,' M. Edward Wilson, MD, distinguished professor and chair of the Department of Ophthalmology at Storm Eye Institute in Charleston, South Carolina, told Medscape Medical News. 'Deprivation by a cataract blocking the light path can cause permanent amblyopia [lazy eye],' he explained. In kids, one of the checkpoints that all babies go through is a check of the red reflexes, he noted. 'Eyes are checked at birth, and they really should be checked at every well visit,' he said. Photo Screeners Popular Cataracts can appear at any time — congenitally, through trauma, or at any development point, Wilson pointed out. Now 'almost every pediatrician's office has a photo screener. It looks like a point-and-shoot camera, and it gives a pass/fail reading. It will pick up anything that blocks light, like a cataract, and they also look for a white pupil that might mean a retinoblastoma, which is the most common eye tumor in childhood.' If pediatricians don't have a photo screener, they can use an ophthalmoscope, he added. He also notes that vision screening now has a billing code, which addresses some complaints in the past that physicians had to buy the screener and they weren't getting reimbursed by payers. Supplements Can't Treat Cataracts Eskew says one misconception about cataracts is that they can be treated with the vitamin supplement AREDS. While supplements do not decrease the risk for cataract formation, 'they do slow the progression of age-related macular degeneration, he explained, which is a condition different from cataracts.' Rivera, Eskew, and Wilson reported having no relevant financial relationships.
Yahoo
30-06-2025
- Business
- Yahoo
The Top 5 Analyst Questions From Bausch + Lomb's Q1 Earnings Call
Bausch + Lomb's first quarter results disappointed investors as both revenue and adjusted earnings fell short of Wall Street's expectations, leading to a sharp market reaction. Management attributed the underperformance primarily to supply disruptions from a voluntary recall of its enVista intraocular lenses and weaker results in the high-margin U.S. Generics pharmaceutical business. CEO Brent Saunders noted that, despite these setbacks, 'our core business is performing well,' highlighting continued strength in the company's Vision Care and Surgical divisions. Ongoing headwinds in Pharmaceuticals, especially in generics, and the financial impact of the recall weighed on overall margins and profitability. Is now the time to buy BLCO? Find out in our full research report (it's free). Revenue: $1.14 billion vs analyst estimates of $1.15 billion (3.5% year-on-year growth, 0.7% miss) Adjusted EPS: -$0.07 vs analyst estimates of $0.02 (significant miss) Adjusted EBITDA: $126 million vs analyst estimates of $163.4 million (11.1% margin, 22.9% miss) The company lifted its revenue guidance for the full year to $5.05 billion at the midpoint from $4.98 billion, a 1.5% increase EBITDA guidance for the full year is $875 million at the midpoint, below analyst estimates of $921.9 million Operating Margin: -7.3%, down from 0.5% in the same quarter last year Constant Currency Revenue rose 5.2% year on year (20.2% in the same quarter last year) Market Capitalization: $4.25 billion While we enjoy listening to the management's commentary, our favorite part of earnings calls are the analyst questions. Those are unscripted and can often highlight topics that management teams would rather avoid or topics where the answer is complicated. Here is what has caught our attention. Patrick Wood (Morgan Stanley) asked about the impact and customer response to the enVista recall. CEO Brent Saunders reported that most customers appreciated the company's transparency and commitment to safety, with many planning to resume use as soon as supply is restored. Young Li (Jefferies) inquired about consumer demand trends, particularly in the U.S. and China. Saunders explained that consumption remained strong, with little sign of discretionary pullback, but noted ongoing retailer inventory destocking as a near-term factor. Joanne Wuensch (Citi) requested updates on the contact lens pipeline and market dynamics. Saunders and Head of R&D Yehia Hashad highlighted the progression of biomimetic lens and myopia control programs, emphasizing that new products are designed to leverage existing manufacturing infrastructure. Unidentified Analyst (Wells Fargo) sought clarity on the timing and magnitude of tariff impacts. CFO Sam Eldessouky projected that immediate actions would shield margins in the first half, with more balanced exposure in the second half, depending on additional mitigation steps. Robbie Marcus (JPMorgan) questioned the exclusion of tariffs from official guidance and potential covenant risks. Saunders and Eldessouky underscored the fluidity of tariff policy and expressed confidence in the company's ability to remain in compliance through ongoing mitigation. In the upcoming quarters, our analysts will be watching (1) the pace of enVista IOL restocking and adoption in the U.S. and international markets, (2) the effectiveness of management's tariff mitigation efforts and any developments in trade policy, and (3) continued sales momentum in flagship brands like MIEBO, XIIDRA, and Daily SiHy contact lenses. Progress in advancing clinical pipeline assets and the launch timing for new IOL and contact lens products will also be important indicators. Bausch + Lomb currently trades at $12.48, down from $13.72 just before the earnings. Is the company at an inflection point that warrants a buy or sell? Find out in our full research report (it's free). Market indices reached historic highs following Donald Trump's presidential victory in November 2024, but the outlook for 2025 is clouded by new trade policies that could impact business confidence and growth. While this has caused many investors to adopt a "fearful" wait-and-see approach, we're leaning into our best ideas that can grow regardless of the political or macroeconomic climate. Take advantage of Mr. Market by checking out our Top 5 Strong Momentum Stocks for this week. This is a curated list of our High Quality stocks that have generated a market-beating return of 183% over the last five years (as of March 31st 2025). Stocks that made our list in 2020 include now familiar names such as Nvidia (+1,545% between March 2020 and March 2025) as well as under-the-radar businesses like the once-micro-cap company Tecnoglass (+1,754% five-year return). Find your next big winner with StockStory today. Error al recuperar los datos Inicia sesión para acceder a tu cartera de valores Error al recuperar los datos Error al recuperar los datos Error al recuperar los datos Error al recuperar los datos
